The world must heed the “harsh lessons” of the COVID-19 pandemic by making “bold investments” in pandemic preparedness, prevention, and response, UN Secretary-General António Guterres said in a statement marking the International Day of Epidemic Preparedness on December 27, 2022. Many wonder, however, as the pandemic fades from our collective memory, whether the global community is—or will be—prepared to face the next pandemic. 

The abilities to detect and analyze potential biological risks are critical to plan for, predict, and respond to disease outbreaks before they reach pandemic levels. Several factors—including climate change and distrust in public health agencies—are accelerating the threat of another pandemic, and various gaps—such as those in leadership, funding, and surveillance—must be filled in order to bolster our ability to face whatever comes next. 

In the United Kingdom, scientists this week launched the Respiratory Virus and Microbiome Initiative, supported by the Wellcome Sanger Institute in cooperation with the UK Health Security Agency, to expand genomic sequencing of various common respiratory pathogens, including SARS-CoV-2 and other coronaviruses, various types of influenza, respiratory syncytial virus (RSV), and other microbes. The program’s goal is to elucidate known threats, detect any worrisome mutations, and potentially alert experts to the emergence of new viruses.

In the United States, the US Congress is facing a deadline next year to reauthorize the Pandemic and All Hazards Preparedness Act, which could provide an opportunity for momentum to instill lessons learned. While lawmakers approved some modest changes as part of a December 2022 pandemic preparedness package—including requiring Senate confirmation of future US CDC directors—a proposal to create a bipartisan commission to evaluate the federal pandemic response, identify gaps, and make recommendations for future actions was dropped. In the US House, now under control of Republicans, a Democrat-formed subcommittee—originally focused on the nation’s poor pandemic response and misinformation surrounding vaccines and treatments—will shift its priorities to examining the origin of SARS-CoV-2, investigating gain-of-function research, and probing federal spending and pandemic-related mandates. Though the CDC is expected to roll out changes in the way it addresses health emergencies, the agency continues to require congressional authority to demand data from states. Meanwhile, several states, private foundations, and academic institutions are exploring ways to institute changes on their own or make recommendations for reform. 

With various sublineages of the Omicron variant of concern (VOC) circulating worldwide—including the XBB.1.5 subvariant that appears to be increasing in prevalence globally—and China facing a severe COVID-19 outbreak, the International Health Regulations (IHR) Emergency Committee for COVID-19 is set to meet January 27 for a fourteenth time to consider whether the pandemic still represents a Public Health Emergency of International Concern (PHEIC). Several leading experts and WHO advisors say it is too early to end the pandemic emergency phase, particularly in light of the situation in China. 

In the US, the Biden administration this week quietly renewed the COVID-19 public health emergency for the eleventh time. Several people familiar with the process say this could be the last renewal, although a decision has not been finalized amid yet another surge in cases. If the emergency declaration is allowed to lapse in the spring, it would mark a significant turning point in the pandemic response, triggering a shift in several significant components of the federal response, such as an end to free vaccinations and tests and the resumption of Medicaid enrollment requirements. Moderna this week said it is considering a commercial price of US$110-$130 per shot for its SARS-CoV-2 vaccine, similar to the price Pfizer-BioNTech said it is considering and likely out of reach for many who do not have health insurance. The cost to consumers would be about 4 times the price the federal government paid to secure vaccine doses. In a letter to Moderna’s CEO, US Senator Bernie Sanders (I-VT) chastised the announcement, saying the proposed price tag is “unacceptable corporate greed.”

The US National Institutes of Health (NIH), in partnership with the Administration for Strategic Preparedness and Response (ASPR) at the US Department of Health and Human Services (HHS), launched a new Home Test to Treat program to provide free at-home rapid tests, free telehealth sessions, and free at-home treatments for COVID-19 in select communities. Berks County, Pennsylvania, will be the first community to pilot the new program, with wider implementation is expected to occur in additional communities that will be selected based on community need, access to healthcare, anticipated COVID-19 incidence rates, and socioeconomic factors. Up to 100,000 individuals may be eligible to take advantage of this program in the coming year. Program leadership hopes the initiative will increase access to COVID-19 health services while potentially reducing community transmission. 

The new program model benefits from avoiding some obstacles of the original Test to Treat program launched last year. Some patients faced difficulties accessing the antiviral treatment Paxlovid, including because of a lack of staff at pharmacies able to prescribe the medicine. Additionally, federal subsidies for the treatment are expected to end early this year, and uninsured individuals likely will be confronted with potentially prohibitive price tags. 

The new program also reflects the greater shift to at-home health services, associated with high demand from patients and increased health seeking behavior in some cases. A study published January 6 in JAMA Health Forum documented that during the first year of the pandemic, March 2020-December 2020, increases in telehealth services for major depressive disorder, anxiety, and adjustment disorders more than compensated for concurrent drops to in-person appointments, increasing overall mental health service utilization for these conditions. Additionally, there’s been massive patient demand for the expansion of rapid at-home tests for diseases beyond COVID-19, such as RSV and flu. 

The value of wastewater surveillance rose to prominence during the COVID-19 pandemic. Now, experts are wondering what the method’s future may look like beyond COVID-19, particularly since the 2020 launch of the US CDC’s National Wastewater Surveillance System (NWSS) program, which aggregates data from federal contractors, academic laboratories, state laboratories, and state-contracted commercial laboratories. However, advocates and experts note that while there are numerous advantages to utilizing wastewater surveillance, further evaluation and investment to determine the best applications of wastewater data are needed. An international meeting this week seeks to determine if a global COVID-19 wastewater monitoring system may provide further value, building off existing European Union recommendations and airport wastewater monitoring programs. The WHO this week urged all nations currently experiencing COVID-19 outbreaks to increase genomic sequencing of SARS-CoV-2 and share those sequences, noting that the number of shared sequences has dropped by more than 90% since the peak of the initial Omicron surge.

See also: If interested in learning more about wastewater surveillance, consider listening to this episode of a new Johns Hopkins Center for Health Security podcast series, The BWC Global Forum: Biotech, Biosecurity & Beyond.

Growing body of evidence supports Omicron-targeting bivalent booster’s benefits over original boosters; some experts question need among younger, healthy populations

A growing body of evidence from lab tests and real-world data suggest the bivalent vaccine boosters targeting the Omicron BA.4/BA.5 subvariants provide broad and better protection than the original boosters against severe COVID-19 outcomes. A recent report in the US CDC’s MMWR shows that a bivalent booster dose provided 73% additional protection against COVID-19 hospitalization among immunocompetent adults aged 65 and older, compared to past monovalent mRNA vaccination only. Among the study population, a bivalent booster dose received after ≥2 monovalent mRNA doses provided strong protection against COVID-19–associated hospitalization during a period of Omicron BA.5 or BQ.1/BQ.1.1 predominance. Newer CDC data show that during November 2022, there was a 90% reduction of hospitalizations for people aged 65 and older who had the bivalent booster compared to those who were unvaccinated, a 13.5-fold increased risk of hospitalization for unvaccinated individuals, and a 2.5-fold risk among those who were vaccinated but not a bivalent booster. An Israeli study found similar results—the Omicron-adapted booster provided an 81% reduction in hospitalization among people aged 65 and older who had received the shot. 

Another recent MMWR study looking at younger adults aged 18 and older found the bivalent booster was 38-57% effective against hospitalization, consistent with, but at a lower magnitude, than protection among older adults. CDC data also support the bivalent booster’s effectiveness in young adults aged 18-49 years, showing monthly rates of COVID-19-associated hospitalizations were 29.9 times higher in unvaccinated individuals in this age group and 3.2 times higher in vaccinated individuals who did not have an updated booster. Some experts—including Dr. Paul Offitt, a member of the FDA’s Vaccines and Related Biological Products Advisory Committee—say some of these data support booster dosing only among those most likely to need protection against severe disease, such as older adults, people with multiple comorbidities that put them at high risk for serious illness, and those who are immunocompromised. To date, only 15.4% of the US population aged 5 years and older have received the updated booster, including 38.1% of those aged 65 and older.

Most long COVID symptoms resolve 1 year after infection, Israeli study shows; more research needed into multiorgan involvement

The vast range of symptoms known as post-COVID conditions, post-acute sequelae of SARS-CoV-2, or, most commonly, long COVID, can persist for a long time in some people. While more research is needed on exactly how SARS-CoV-2 infection impacts the body, many scientists and doctors are coming to understand that COVID-19 can affect multiple organ systems, as well as cognition and mental health. 

A study posted online in the journal Neuropsychology analyzed data from neuropsychological evaluations of 110 adults who had confirmed SARS-CoV-2 infection 12 months prior to enrollment to identify demographic and clinical predictors of cognitive dysfunctions and complaints. Based on the findings, about half the study participants had abnormal performance in at least 1 of 3 cognitive tests, and lower educational background and acute infection-related headache and sleep disturbance were critical predictors of cognitive dysfunction.

Among more than 4,100 US children and adolescents hospitalized with post-COVID multisystem inflammatory syndrome in children (MIS-C), deaths, length of stay, adverse drug reactions, and the proportion of Black patients rose along with the number of organ systems involved, according to a study published January 5 in JAMA Network Open. In related news, the US NIH announced it has awarded 8 research grants to refine new technologies for early diagnosis of severe illnesses resulting from SARS-CoV-2 infection in children, including MIS-C.

For a study published January 11 in the journal BMJ, Israeli researchers examined nearly 2 million patient records, concluding that long COVID symptoms resolve within the first year after infection for most people with mild cases. Notably, several common symptoms of long COVID, such as fatigue, post-exertional malaise, and dysautonomia/POTS, were not included in the study, presenting a major limitation.

VACCINATION DISPARITIES COVID-19 vaccination rates among US children aged 5 to 17 years vary widely, with the highest coverage among Asian youth and the lowest among Black children, according to a study published in the US CDC’s MMWR. The authors state that providers and trusted messengers should provide culturally relevant information and vaccine recommendations to increase overall vaccination coverage and address disparities.

OMICRON NOMENCLATURE Do we really need to be keeping track of the “alphabet soup” of Omicron variant offspring? Do nicknames like “Kraken” help keep it all straight or add another layer of complexity? Does keeping up with the sublineage help people take actions to protect themselves and others, such as getting booster vaccines or wearing masks, or does it confuse such messaging? The Atlantic, STAT, and Fortune examine these questions. 

SITUATION IN CHINA China is in the midst of what could be the world’s largest COVID-19 outbreak, but there are no reliable data about who has been infected, hospitalized, or died. The government stopped reporting daily COVID-19 data on January 9, saying it will switch to monthly reports. Both the Washington Post and the New York Times this week published pieces helping to visualize what appears to be a serious situation, using satellite imagery, photos, and videos.

VACCINE DELIVERY IN LMICs An initiative that helped bring COVID-19 vaccines to low- and middle-income countries (LMICs), the COVID-19 Vaccine Delivery Partnership, is winding down in June. The partnership—among Gavi, the Vaccine Alliance; UNICEF; and the WHO—was never meant to be permanent, will continue to support countries’ vaccination campaigns in the coming months, and help examine how to improve future vaccine deliveries, according to reporting by Devex. 

As of January 12, the WHO COVID-19 Dashboard reports: 

Over the previous week, incidence declined 33% in Europe; 27% in South-East Asia; 7% in the Americas; 1% in the Eastern Mediterranean; and 1% in Africa, and increased 3% in the Western Pacific.

The US CDC is reporting: 

The Omicron sublineages BQ.1.1 (34%), XBB.1.5 (28%), and BQ.1 (21%) account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases.

Editor: Alyson Browett, MPH

Contributors: Erin Fink, MS; Clint Haines, MS; Noelle Huhn, MSPH; Amanda Kobokovich, MPH; Aishwarya Nagar, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; and Rachel A. Vahey, MHS